We propose a five-year Demonstration and Education project to assess the incremental value of peak flow monitoring (PFM) over symptom monitoring (SM) as a management tool for asthma control in adults greater than or equal to 50 years with moderate-severe asthma. We will develop three parallel asthma education programs for older adults using as our base an existing asthma education program (AIR/Kaiser Adult Education Program) of demonstrated efficacy for adults ,50 years of age. All three programs will incorporate the same educational and behavioral techniques and include symptom monitoring. Two of the programs will also incorporate PFM, one on a regular (twice daily) basis, and one on an "as needed" basis. For these latter two programs, peak flow measurements will be used as the basis for monitoring asthma control; for the third, symptoms alone will be used to monitor asthma control. The project will have two phases. In Phase 1, the AIR/Kaiser program will be adapted to be appropriate for an older age group and to incorporate he two strategies for PFM. The three interventions will then be tested in small groups of patients greater than or equal to 50 years with moderate-severe asthma (total N=60). We will also do a substudy of peak flow compliance in a group of 30 subjects, In Phase 2, 268 patients with moderate-severe asthma will be randomized on a 1/2:1/1:1 basis into the three intervention programs (three weekly sessions of 90 minutes each), which will run concurrently. Each arm will have approximately equal representation from both genders and two age groups (50-64, >65 years). Follow-up involve phone contacts every three months and in-clinic visits every six months for two years. Primary outcome variables will be health care utilization and asthma-specific quality of life. Secondary outcomes will be average lung function, measured by one-second forced expiratory volume, over the follow-up period, and diurnal variation in peak flow. The PFM programs, when compared to the SM program, will test the incremental effectiveness of PFM when initiated with appropriate, fundamental instruction in asthma managements.